For teens especially, having complexion-marring acne can erode self-confidence during a life stage when fitting in with peers is often of utmost importance.
And while adolescence may be the time when acne is at its worst, that doesn't mean having to accept a face full of zits, as there are a host of treatments that can clear the complexion and prevent permanent scarring, dermatologists say.
"People think they just have to wait it out, it's a rite of passage," says Vancouver dermatologist Dr. Jason Rivers, president of the Acne and Rosacea Society of Canada. "But the impact of acne on people can be lifelong."
"It's not just that 'OK, I have acne now. It goes with being a teen.' But if you have the scars as a result of it, it can have a negative emotional impact on people well into their 40s. I've seen that."
Acne, which occurs when hair follicles in the skin become plugged with oil and dead skin cells, typically appears on the face, neck, chest, back and shoulders — areas that contain the most sebaceous glands.
Hair follicles are connected to these glands, which secrete an oily lubricating substance called sebum. When excess sebum is produced, it can combine with dead skin cells, forming a plug in hair follicles that can become infected with bacteria. This can result in the formation of whiteheads (closed pores) or blackheads (open pores).
Whiteheads and blackheads, known as comedones, are generally non-inflammatory lesions, says Rivers. But acne can also involve inflammatory lesions, such as papules (small red bumps), pustules (pus-filled bumps) and nodules (large painful lumps beneath the skin's surface).
"If the acne becomes more significant, if there's more inflammation, then those individuals get deep-seated nodules or cysts even," he says. "And the issue with all of this is that in a lot individuals, scarring can eventuate, and that's what we're trying to prevent."
Luis Confeiteiro was lucky — he doesn't have acne scars on his face — but he remembers how having a spotty complexion during five years of high school diminished his self-esteem.
"I felt insecure and I did lose confidence at times," says Confeiteiro, 20, of Burnaby, B.C. "Image is so big at high school. If you don't feel good about your appearance, you're going to be kind of miserable, especially talking to other people."
"If I wanted to talk to a girl, pimples and my acne would always be in the back of my head, every time I would talk. And it would make me shy. I'd kind of avoid conversations."
While he tried some over-the-counter acne medications, Confeiteiro says they didn't work for him. And he didn't see a doctor for his pimples, something he regrets.
"A lot of teens, they think this is just a phase. You're a teenager, puberty, it's all part of the whole stage where it will just stay there for a couple of years and it will go away. But for some people it doesn't go away and it's a serious problem."
Rivers says about 90 per cent of teens get some degree of acne, which is fuelled by hormonal changes during puberty that cause sebaceous glands to produce more sebum. But graduating from adolescence doesn't necessarily mean saying goodbye forever to zits: almost a quarter of adults — particularly women — will get break-outs at some point in their lifetime.
Diet may also play a role: certain foods, such as dairy products and carbohydrate-rich foods, can lead to pimples; stress and some medications, including lithium and those containing corticosteroids or androgens, can worsen acne.
When it comes to treatment, there are a number of over-the-counter products that people can try, says Rivers, noting that they generally contain such acne-fighting ingredients as benzoyl peroxide, acetylsalicylic acid or alpha hydroxy acid.
But for stubborn cases that don't respond to such products, he says dermatologists can prescribe a number of medications, including topical and oral antibiotics. However, doctors try to minimize patients' exposure to those drugs to prevent bacteria from becoming resistant to their effects.
Depending on the patient and the type of acne, doctors also have other medicines in their tool kit, among them topical retinoids and, for females, low-dose birth control pills or agents that block androgen hormones like testosterone.
The drug isotretinoin is reserved for people with the most severe acne, which has not responded to other treatments. Because of potential serious side-effects — ulcerative colitis, an increased risk of depression and suicide, and severe birth defects in offspring — doctors must closely monitor any patient taking this drug. Women who are pregnant, breastfeeding or planning to get pregnant should not be prescribed the medication.
For Jessica Miskiewicz, 29, isotretinoin was the only drug that worked on her acne, which she has dealt with on and off since about age 14.
"I've used a whole slew of different products, spending a lot of money on different names, things I've seen on commercials. And it really didn't resolve my acne," says the Vancouver resident.
About a year ago, when her acne flared up, she was prescribed isotretinoin by her dermatologist — though she realizes it's not appropriate for everyone.
"I wish I would have done it sooner. It definitely cleared up my complexion. And now I'm getting compliments all the time about how great my skin looks," says Miskiewicz, who had regular blood tests and monitoring while taking the medication for six months.
Six months may seem like a long time, but Rivers says acne treatments don't work overnight and people need to be patient.
"It takes a couple of months to see some improvement in general, especially for moderate or severe acne," he stresses. "So people need to use (their medications) for more than a day or two, and don't just chuck them out before they say it's not working."
About one in five teens will get acne scars on the face, but they don't always have to be permanent: in some cases, scarring can be reduced with a chemical peel, laser treatment or dermal filler that smoothes out the void where scars have occurred.
Rivers says that although acne is common, the condition shouldn't be taken lightly. "The rate of depression in acne is significant. It runs around 10 per cent, and for some people even minor acne can have as significant an impact as serious acne can on the well-being of the person."
"Some studies have shown that not only is it associated with teasing and bullying, but also eating disorders and people feeling isolated or anxious," he says.
"So for teens, at least, acne is a very major disease and is probably their No. 1 disease of concern."
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Acne and Rosacea Society of Canada: www.acneaction.ca